Provider Demographics
NPI:1073738506
Name:CARSON, JASMINE DENISE (NP)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:DENISE
Last Name:CARSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13570 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-2012
Mailing Address - Country:US
Mailing Address - Phone:706-907-0932
Mailing Address - Fax:706-657-2958
Practice Address - Street 1:11638 HIGHWAY 27 STE 8
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-8515
Practice Address - Country:US
Practice Address - Phone:706-907-0932
Practice Address - Fax:706-657-2958
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA32953722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003151883AMedicaid
GA00842388BMedicaid
GA003151883AMedicaid
GA111985Medicare Oscar/Certification